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Advance Decisions to Refuse Treatment in Cases of Dementia
  1. Joanna Davies,
  2. Rob George
  1. Joanna Davies, Specialist Registrar, Palliative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, and Rob George, Professor, Palliative Care, Cicely Saunders Institute, King’s College London, and Consultant Physician, Palliative Care, Guy’s and St Thomas’ NHS Foundation Trust, London. Email:{at}


Evaluating someone’s mental capacity in relation to advance decisions to refuse treatment can be a challenge for health professionals, particularly in cases of dementia. The Mental Capacity Act 2005 clarifies and formalises the functional assessment of capacity. It aims to protect individual autonomy and counter the assumption that, just because an individual does not have capacity regarding one aspect of their life, it does not mean they do not have capacity to make any decisions at all. This article discusses the ethical and legal frameworks for approaching decision-making processes in relation to a complex case of an adult with dementia who, before its onset, drew up an advance decision to refuse treatment to be implemented in the event that she lost mental capacity for decision-making. However, when the time came her family and carers wanted her GP to ignore the advance refusal document. In such cases it is important that health professionals aim to carry out best interest-based decision-making within the wider context of patients’ lives. Conflicts of interest: none

  • Advance decisions to refuse
  • treatment
  • Best interests
  • Dementia
  • Mental Capacity Act 2005

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